Severe Chronic Mental Illness Research Articles

Retinal Nerve Fiber Layer Thickness in Patients with Schizophrenia and Its Relation with Cognitive Impairment.

Schizophrenia is a chronic severe mental illness with heterogeneous clinical presentation, course, and outcome. Cognitive impairment is one of its core features. Retinal nerve fiber layer (RNFL) imaging using OCT (optical coherence tomography) could provide easy access for in vivo imaging of the retina, rendering it as a "window to the brain." Studies done on schizophrenia have shown RNFL thinning. This study attempts to look into the association between cognitive impairment, disease duration, and RNFL abnormality in patients with schizophrenia using OCT. Patients diagnosed with schizophrenia meeting DSM 5 (Diagnostic and Statistical Manual of Mental Disorders) criteria and who were confirmed to be in remission for at least six months clinically and scoring less than three on PANSS-8 (positive and negative symptom scale-8) remission scale were included. They were administered the Montreal Cognitive Assessment Scale (MoCA) for cognitive assessment. RNFL measures were taken using spectral domain-OCT. Variables were compared using Pearson's correlation test, one-way ANOVA test, and independent t-test as appropriate. A total of 36 patients were studied. MoCA scores and RNFL thickness showed a positive correlation. Patients with schizophrenia had reduced average RNFL thickness and reduced RNFL thickness in superior, inferior, and temporal quadrants. Average RNFL thickness, Superior and inferior quadrant RNFL thickness showed a positive correlation with MoCA scores. No correlation was obtained between macular volume, macular thickness, duration of illness, and MoCA scores. Patients with schizophrenia have reduced average RNFL thickness. Patients with low MoCA scores have RNFL thinning.

Safe discontinuation of psychotropic drugs in older people? : New evidence and practical approach

Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. After removal of duplications, 12heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of ahistory of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients.

Wait for Me: Chronic Mental Illness and Experiences of Time During the Pandemic.

As someone diagnosed with severe chronic mental illness early in my adolescence, I have spent over half of my life feeling out of step with the rest of the world due to hospitalizations, treatment programs, and the disruptions caused by anxiety, anorexia, depression, and obsessive-compulsive disorder. The effect of my mental health conditions compounded by these treatment environments means I often feel that I experience time passing differently, which results in sensations of removal and isolation from those around me. The global shutdown caused by the COVID-19 pandemic seemed a way for normative bodies to experience the passing of time the way I always have. In this paper, I extend Dr. Sara Wasson's analysis of the ways in which chronic pain resists narrative coherence to my own temporal experience of chronic mental illness, specifically my embodied experience of the pandemic. I use that embodied experience as a case study for examining how the reciprocal nature of time and narrativity, as outlined by Dr. Paul Ricoeur, can create isolation for those struggling with their temporality due to chronic mental illness. To acknowledge and grapple with the ramifications of discursive and material privilege involved in such situations, I include an analysis of Robert Desjarlais's 1994 article "Struggling Along: The Possibilities for Experience among the Homeless Mentally Ill," in which he investigates a similar phenomenon of being outside ofstructured sequential narrative timein the residents of a Boston shelter for the mentally ill.

Microneedle array patches for sustained delivery of fluphenazine: A micron scale approach for the management of schizophrenia

Schizophrenia is a severe chronic mental illness characterised by impaired emotional and cognitive functioning. To treat this condition, antipsychotics are available in limited dosage forms, mainly oral and injectable formulations. Although injectable antipsychotics were designed to enhance adherence, they are invasive, painful and require a healthcare professional to be administered. To overcome such administration issues, extensive research has been focused on developing transdermal antipsychotic formulations. In this work, three microneedle (MN) systems were developed to deliver fluphenazine (FLU) systemically. A decanoic prodrug of FLU called fluphenazine decanoate (FLUD) was used in two of the MN formulations due to its high lipophilicity. FLU-D was loaded into dissolving MNs and nanoemulsion (NE)-loaded MNs. The parent drug FLU was loaded into poly(lactic-co-glycolic acid) (PLGA)-tipped MNs. All MN systems were characterised and evaluated in vitro and in vivo. The in vivo evaluation of the three developed MN systems showed their ability to deliver FLU into the systemic circulation, as the Cmax of FLU-D dissolving MNs was 36.11 ± 12.37 ng/ml. However, the Cmax of FLU-D NE loaded dissolving MNs was 12.92 ± 6.3 ng/ml and for FLU-PLGA tipped MNs was 21.57 ± 2.45 ng/ml. Compared to an intramuscular (IM) injection of FLU-D in sesame oil, the relative bioavailabilities were 26.96 %, 21.73 % and 42.45 % for FLU-D dissolving MNs, FLU-D NE dissolving MNs and FLU-PLGA tipped MNs, respectively. FLU plasma levels were maintained above the minimum human therapeutic limits for a week. Consequently, these various MN formulations are considered to be a viable options for the transdermal delivery of fluphenazine and its prodrug. The three MN systems developed offer patients a user-friendly, painless, and convenient long-acting delivery method for FLU. Reducing dosing frequency and using less invasive drug administration methods can enhance adherence and foster positive therapeutic outcomes. This study demonstrates the capability and adaptability of MNs technology to transport hydrophobic molecules from the skin to the systemic circulation.

Safe discontinuation of psychotropic drugs in older people? : New evidence and practical approach

Many older patients are permanently prescribed one or more psychotropic drugs for treatment of symptoms, such as behavioral and psychological symptoms in dementia, depressive symptoms, anxiety, and insomnia. They therefore contribute to the risk of polypharmacy. Recently, deprescribing studies have been published in order to clarify if inadequate medications can be safely discontinued. This mini-review summarizes the study results and derives practical recommendations for routine use. A literature search was carried out in PubMed for clinical studies on deprescribing in association with psychotropic substances. After removal of duplications, 12heterogeneous clinical studies were identified and reduction of psychotropic substances could be successfully achieved in 8studies. In four of these studies psychological, behavioral and functional endpoints were reported. Criteria for successful deprescribing of sedatives were in particular motivation, information and sufficient cooperation of the patients and for antipsychotic drugs in people with dementia, the sustainable establishment of nonpharmaceutical treatment strategies. Deprescribing was not attempted in cases of ahistory of severe chronic mental illness and in cases of severe behavioral symptoms in dementia. Evidence for antidepressants was not sufficient to extract practical recommendations. Safe deprescribing of antipsychotic drugs in patients with dementia is justified if non-pharmacological treatment options are sustainably implemented, and for sedative drugs in well-informed, highly motivated and cooperative patients.

Vanadium in Bipolar Disorders-Reviving an Old Hypothesis.

Bipolar disorder (BD) is a severe and common chronic mental illness. The biological basis of the disease is poorly understood and its treatment is unsatisfactory. Our previous studies supported the notion that alterations in Na+, K+-ATPase activity were involved in the etiology of BD. As various chemical elements inhibit Na+, K+-ATPase, we determined the concentration of 26 elements in the serum of BD patients before and after treatment and in postmortem brain samples from BD patients, and compared them with matched controls. The only element that was reduced significantly in the serum following treatment was vanadium (V). Furthermore, the concentration of V was significantly lower in the pre-frontal cortex of BD patients compared with that of the controls. Intracerebroventricular administration of V in mice elicited anxiolytic and depressive activities, concomitantly inhibited brain Na+, K+-ATPase activity, and increased extracellular signal-regulated kinase phosphorylation. A hypothesis associating V with BD was set forth decades ago but eventually faded out. Our results are in accord with the hypothesis and advocate for a thorough examination of the possible involvement of chemical elements, V in particular, in BD.

Pilot Mental Health Offender Program Improves Participant Outcomes and Lowers Costs in a Large Urban County.

Mass incarceration, particularly of the mentally ill, continues to pervade our criminal justice system. Jails in many areas have become the largest mental health facilities, especially in large urban communities, despite increasing societal recognition that those with mental illness are not best served behind bars. Misdemeanors are an often-overlooked contributor to mass incarceration, and may be preventable for those with chronic severe mental illness. This Northeast Florida pilot program, the Mental Health Offenders Program (MHOP), is based on the successful Miami Eleventh Circuit Court Criminal Mental Health Project. MHOP provided pretrial release from custody, through diversion with a customized plan of care to stabilize defendants, using court supervision to ensure compliance. With community partners, the MHOP pilot enrolled 20 individuals with chronic severe mental illness and recurrent misdemeanor charges; 15 were able to continue in the program with stabilization of their mental health and reduction of county costs both documented. The MHOP pilot demonstrates that community resources can be successfully shifted to benefit mentally ill, non-violent offenders and the larger community by helping severely mentally ill clients achieve stability by providing healthcare, housing, and income, while decreasing costs for the community in a humane way.

Chaos Unleashed: The impact of recreational drugs and COVID on young adults

IntroductionThis case series reveals a number of young adults, whom after chronic use of recreational drugs, suffer the life-long consequence of severe chronic mental illness.Objectives• Review the illicit drugs that are commonly associated with psychotic symptoms. • Highlight exposures theorized to impact genetics associated with DSM 5 diseases. • Compare trends in illicit drug use during the worldwide COVID pandemic.MethodsA literature review is used to examine the impact of COVID pandemic on illicit drug use in metropolitan cities in European countries and compare the trends with what is seen by the consult liaison psychiatry service at a metropolitan community hospital in the USA.ResultsIn European Countries with data available, there were measurable differences in which illicit drugs were used most during the COVID 19 pandemic. In the US this data is not readily available at the time of submission for proper comparisson.ConclusionsAlthough definitive comparrison is pending, the results of extensive illicit drug use demostrate a high comorbidity with psychotic spectrum disorders in the DSM 5.DisclosureNo significant relationships.

A Review of Factors Relating to Medication Non-Adherence in Patients with Schizophrenia

Schizophrenia is a severe chronic mental illness affecting twenty million people worldwide. Although the incidence of schizophrenia remains low, its prevalence may remain high due to medication non-adherence. Knowing potential factors relating to non-adherence with medication among patients with schizophrenia by investigating existing literature is needed in order to understand the phenomenology of this situation. Therefore, the study aimed to explore the most common factors that affected medication non-adherence in patients with schizophrenia. A systematic review was conducted through a literature search on Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, EBSCOhost, CINAHL Complete, ERIC, and Allied Health databases published from 1980 to 2021. Database searches were conducted with the terms “non-adherence to medication” “schizophrenia,” and “factors.” Eighty-six articles were found following the first-round search. Then seventy-eight articles were excluded due to irrelevant and duplicate tiles. Only eight articles were included for the final review. Per the findings, factors associated with medication non-adherence were categorized into four main themes: individual characteristics, cognitive appraisal, social influence, and health-care service. To improve medication adherence rates in patients with schizophrenia, psychiatric nurses must consider these specific factors while establishing nursing interventions.

Complicated Grief, Depression, Health and Attachment Style in First Degree Relatives of Individuals with a Chronic Psychotic Disorders.

Complicated grief (CG) is a form of unrelenting grief after the death of a loved one. However, family members of individuals who suffer from Schizophrenia, Schizoaffective disorders and Bipolar disorder may experience symptoms of CG even though their loved one is still alive. The present study assessed CG and risk factors for CG in first degree relatives of individuals with severe chronic mental illness. The incidence of CG was examined in 78 parents, siblings, adult children and spouses recruited through organizations and social media that provide support services for individuals suffering from mental illness and their families. High rates of CG (39.7%) were found in this group. CG was associated with a higher prevalence of posttraumatic and depression symptoms and poorer physical health. These findings may contribute to heightening therapists' awareness of the importance of assessing, acknowledging and resolving CG in the family members of patients with chronic psychotic disorders.

Structural and Functional Alterations of the Temporal lobe in Schizophrenia: A Literature Review.

Schizophrenia is a severe chronic mental illness leading to social and occupational dysfunction. Our primary focus in this review article was to analyze further the structural and functional alterations of the temporal lobe in patients with schizophrenia, which might contribute to the associated manifestations we often see in this illness. Our goal was to see if there was any correlation between temporal lobe abnormalities, more specifically, alterations in brain volume and specific symptoms such as auditory and language processing, etc. There is a positive correlation between volume alterations and thoughts disorders in the temporal lobe in the majority of studies. However, superior temporal gyrus volume has also been correlated negatively with the severity of hallucinations and thought disorders in some studies. We utilized Medical Subject Heading (MeSH) search strategy via PubMed database in our articles search yielding 241 papers. After the application of specific inclusion and exclusion criteria, a final number of 30 was reviewed. The involvement of the temporal lobe and its gray and white matter volume alterations in schizophrenia is quite apparent from our research; however, the exact mechanism of the underlying biological process is not thoroughly studied yet. Therefore, further research on larger cohorts combining different imaging modalities including volumetry, diffusion tensor, and functional imaging is required to explain how the progressive brain changes affect the various structural, functional, and metabolic activities of the temporal lobe in schizophrenia.

Employment Vulnerability of People With Severe Mental Illness

Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.

Oral supplementation of Sea Buckthorn (Hippophae rhamnoides L. spp. Turkestanica) fruit extract modifies haloperidol induced behavioral deficits and increases brain serotonin metabolism

Pulp and oils (fruit extract) from Sea Buckthorn (Hippophae rhamnoides L. spp. Turkestanica) (HRL) seeds and berries have been traditionally used in the treatment of different clinical and psychotic disorders and have significant implication in contemporary medicinal therapy. Schizophrenia is a chronic severe mental illness that affects approximately 1% of the population. Although the first generation of antipsychotic drugs such as chlorpromazine and haloperidol are widely prescribed for the treatment of schizophrenia, their beneficial effects are accompanied by extrapyramidal side effects (EPS). The present study was designed to investigate the effects of oral supplementation of HRL fruit extract (HRL-FE) on behavioral deficits and changes in brain serotonin (5-hydroxytryptamine; 5-HT) metabolism in rats administered with haloperidol repeatedly (two times a day at 09:00-09:30 A.M. and 05:00-05:30 P.M. at dose of 3.0 mg/kg body weight for two weeks. Results revealed that after two weeks of oral administration of HRL-FE (4.0 mg/kg body weight), rats exhibited significant (p<0.01) increases in locomotor activity in home cages and exploratory activity in open field arena. Repeated haloperidol treatment significantly (p<0.01) decreased brain tryptophan (TRP) and 5-HT and these decreases were reversed by 4.0 mg/kg body weight HRL-FE. These data suggest that HRL-FE plays a modifying role against the haloperidol induced behavioral deficits and could further extend as a nutritive therapy to conventional antipsychotic treatment in schizophrenia.

The serotonergic and alpha-1 adrenergic receptor modulator ACH-000029 ameliorates anxiety-like behavior in a post-traumatic stress disorder model

Post-traumatic stress disorder (PTSD) is a severe chronic mental illness that develops in individuals exposed to life-threatening trauma and is characterized by hyperarousal, flashbacks and nightmares. The serotonergic (5-HT) and noradrenergic (NE) systems are deeply involved in the pathogenesis of PTSD. We have previously reported a novel anxiolytic compound, ACH-000029, that modulates 5-HT and α1-adrenergic receptors and induces acute anxiolytic-like effects in rodents. Here, we investigated the potential of ACH-000029 to prevent anxiety-like behavior in the single prolonged stress (SPS) PTSD model. Mice were subjected to the SPS procedure, followed by a 7-day treatment with ACH-000029 and, for comparison, with the α1-adrenergic antagonist prazosin. Animals were behaviorally assessed using social interaction, elevated plus maze and open field tests. Interestingly, treatment with ACH-000029 but not with prazosin ameliorated the SPS-induced sociability impairment and anxiety-like behavior. The brain-wide c-fos mapping, used as a surrogate for brain activity, indicated the brain structures that were altered by SPS and putatively involved in the anxiolytic-like effect of ACH-000029. The SPS protocol produced long-lasting impairment of regions involved in stress-anxiety response, such as the amygdala, prefrontal cortex, globus pallidus and superior colliculus. ACH-000029 treatment reversed the SPS-induced c-fos changes in the globus pallidus, lateral septum and entorhinal cortex and exclusively modulated c-fos levels in subregions from the retrosplenial cortex, cerebellum, superior colliculus and ventromedial hypothalamus. These results support the hypothesis that the dual regulation of 5-HT and α1-adrenergic receptors is required to alleviate PTSD symptoms and suggest a possible role of ACH-000029 as a PTSD treatment.

Psychosocial rehabilitation and severe mental illness: Factors that influence patients' attendance in a support group

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.

Na⁺, K⁺-ATPase Signaling and Bipolar Disorder.

Bipolar disorder (BD) is a severe and common chronic mental illness characterized by recurrent mood swings between depression and mania. The biological basis of the disease is poorly understood and its treatment is unsatisfactory. Although in past decades the “monoamine hypothesis” has dominated our understanding of both the pathophysiology of depressive disorders and the action of pharmacological treatments, recent studies focus on the involvement of additional neurotransmitters/neuromodulators systems and cellular processes in BD. Here, evidence for the participation of Na+, K+-ATPase and its endogenous regulators, the endogenous cardiac steroids (ECS), in the etiology of BD is reviewed. Proof for the involvement of brain Na+, K+-ATPase and ECS in behavior is summarized and it is hypothesized that ECS-Na+, K+-ATPase-induced activation of intracellular signaling participates in the mechanisms underlying BD. We propose that the activation of ERK, AKT, and NFκB, resulting from ECS-Na+, K+-ATPase interaction, modifies neuronal activity and neurotransmission which, in turn, participate in the regulation of behavior and BD. These observations suggest Na+, K+-ATPase-mediated signaling is a potential target for drug development for the treatment of BD.

A Study of Sexual Dysfunction in a Sample of Medicated and non Medicated Egyptian Female Patients with Schizophrenia

Background: the relationship between sexuality and schizophrenia is complex. It may be related to both the psychopathology and the pharmacotherapy, as the sexual functions may be affected by symptoms itself, living with a severe chronic mental health illness, and the adverse effects of antipsychotics or other medications. Systematic studies have revealed that sexual dysfunction is highly prevalent in both untreated and treated schizophrenia patients, affecting 30–80% of women and 45–80% of men. The prevalence of sexual dysfunction may be higher in patients with schizophrenia than in patients treated for other mental disorders. Aim of the Work: to compare a group of females with Schizophrenia to healthy female control group regarding frequency and type of sexual dysfunction. Patients and Methods: this study was sought to extend our knowledge about the association of schizophrenia and its treatment with sexuality problems. It was done at Institute of Psychiatry, Faculty of Medicine, Ain Shams University to determine the rate of occurrence of sexual dysfunctions in married females with schizophrenia in comparison to control group. It included 90 females diagnosed as schizophrenia (divided into 3 groups of 30s 1-untreated patients 2-patients treated with typical anti psychotics 3- patients treated with Atypical antipsychotics) and 30 females as a control group. Results: the study revealed high prevalence of sexual dysfunction among all patients group yet it was highest among the drug naive group as 100% of them had sexual dysfunction. Conclusion: the relation between schizophrenia and female sexuality is complex it could be the result of side effect of antipsychotic medications yet the high prevalence of sexual dysfunction among drug naive patients, suggest that sexual dysfunction is an integral part of the disease.

A Study of Sexual Dysfunction in a Sample of Medicated and non Medicated Egyptian Female Patients with Schizophrenia

Background: the relationship between sexuality and schizophrenia is complex. It may be related to both the psychopathology and the pharmacotherapy, as the sexual functions may be affected by symptoms itself, living with a severe chronic mental health illness, and the adverse effects of antipsychotics or other medications. Systematic studies have revealed that sexual dysfunction is highly prevalent in both untreated and treated schizophrenia patients, affecting 30–80% of women and 45–80% of men. The prevalence of sexual dysfunction may be higher in patients with schizophrenia than in patients treated for other mental disorders. Aim of the Work: to compare a group of females with Schizophrenia to healthy female control group regarding frequency and type of sexual dysfunction. Patients and Methods: this study was sought to extend our knowledge about the association of schizophrenia and its treatment with sexuality problems. It was done at Institute of Psychiatry, Faculty of Medicine, Ain Shams University to determine the rate of occurrence of sexual dysfunctions in married females with schizophrenia in comparison to control group. It included 90 females diagnosed as schizophrenia (divided into 3 groups of 30s 1-untreated patients 2-patients treated with typical anti psychotics 3- patients treated with Atypical antipsychotics) and 30 females as a control group. Results: the study revealed high prevalence of sexual dysfunction among all patients group yet it was highest among the drug naive group as 100% of them had sexual dysfunction. Conclusion: the relation between schizophrenia and female sexuality is complex it could be the result of side effect of antipsychotic medications yet the high prevalence of sexual dysfunction among drug naive patients, suggest that sexual dysfunction is an integral part of the disease.

F161. BRAIN VOLUME CHANGE IN PATIENTS WITH SCHIZOPHRENIA AND ITS RELATION WITH ANTIPSYCHOTIC DRUG USE

BackgroundSchizophrenia is a chronic severe mental illness affecting 0.4% of the society with its early age of onset (generally between 15–25 years) which can be seen in people from all social strata, has recurrent episodes or relapses, and causes disability by deteriorating interpersonal and occupational functioning. Critical behavioral findings accelerated the efforts on understanding the neurobiology of this complex disorder. Although the nature of progressive structural brain change is not understood completely, identifying the role of antipsychotic drugs is important to comprehend how much of the progressive brain volume change is the result of schizophrenia.The purpose of the study is to perform the volumetric brain magnetic resonance imaging (MRI) from patients with schizophrenia, to repeat the MRI after one year regular follow-up, to investigate whether brain volume-brain structures’ volume change by time and reveal its relationship with the type and dosage of antipsychotic drug (APD). This study is considered that would contribute to the discussions about the disease process of schizophrenia and the effect of APD use on structural changes in brain.MethodsFifty-two patients diagnosed with schizophrenia according to DSM IV was participated to the study. Patients are followed for approximately 14 months. In the first interview, patients were applied to a sociodemographic form, The Structured Clinical Interview for DSM-IV (SCID-I), Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI). After the first interviews, the patients who performed brain MR were arranged control meetings by the same doctor regularly (monthly, bimonthly, or when needed) until the second MR. In control meetings, patients were applied to clinical interview form, PANSS, GAF, and CGI. Drugs were recorded regularly by making sure that they took the drugs precisely with the help of their families. Chlorpromazine equivalent doses of APDs were calculated as milligram (mg) and turned into dose-year unit. Second MRIs were performed approximately after 14 months. In SPM program, paired sample t test was used to compare two MRIs and see whether gray matter volume was changed regardless the type of drugs the person used. Also, ANOVA was used to identify the relationship between the type of the drug taken between two MRIs and the volume change in gray matter by choosing the drug type as covariant. SPSS 22 was used to examine the relationship between the sociodemographic features of the patients and their brain volume findings.ResultsFrom the patients participated in our study, 19 of them were female and 33 were male, mean age was 36.5, the level of education was 11 years, the mean onset of the disease was 24 and duration of the illness was 11 years. On the first MRI analyses, gray matter was negatively correlated with the age of the patients (r= -0,473, p<0,001) and the duration of the illness (r=-0,316, p<0,05), and positively correlated with the onset of the disease (r= 0,281, p<0,05) and the level of education (r= 0,321, p<0,05); while white matter positively correlated only with the level of education (r= 0,321, p<0,05). Throughout 14 months, no significant difference was found in brain volume change analysis with 95% confidence. Gray matter was not significantly correlated with APD dose, atypical antipsychotic drug (AAPD) use, and typical antipsychotic drug (TAPD) use.DiscussionIt can be concluded that throughout 14 months period, brain volume of the patients with schizophrenia was not change significantly and the type and dose of APD used during this process did not have any effects on volume change.

Monte Carlo Simulations Demonstrate Algorithmic Interventions Over Time Reduce Hospitalisation in Patients With Schizophrenia and Bipolar Disorder.

Non-adherence with pharmacologic treatment is associated with increased rates of relapse and rehospitalisation among patients with schizophrenia and bipolar disorder. To improve treatment response, remission, and recovery, research efforts are still needed to elucidate how to effectively map patient’s response to medication treatment including both therapeutic and adverse effects, compliance, and satisfaction in the prodromal phase of illness (ie, the time period in between direct clinical consultation and relapse). The Actionable Intime Insights (AI2) application draws information from Australian Medicare administrative claims records in real time when compliance with treatment does not meet best practice guidelines for managing chronic severe mental illness. Subsequently, the AI2 application alerts clinicians and patients when patients do not adhere to guidelines for treatment. The aim of this study was to evaluate the impact of the AI2 application on the risk of hospitalisation among simulated patients with schizophrenia and bipolar disorder. Monte Carlo simulation methodology was used to estimate the impact of the AI2 intervention on the probability of hospitalisation over a 2-year period. Results indicated that when the AI2 algorithmic intervention had an efficacy level of (>0.6), over 80% of actioned alerts were contributing to reduced hospitalisation risk among the simulated patients. Such findings indicate the potential utility of the AI2 application should replication studies validate its methodologic and ecological rigour in real-world settings.